舒肝解郁胶囊联合西药治疗伴抑郁的胃食管反流病疗效观察

[目的]观察舒肝解郁胶囊联合西药治疗伴抑郁的胃食管反流病(GERD)患者的疗效.[方法]将117例伴抑郁的GERD患者随机分为2组,对照组给予埃索美拉唑和多潘立酮治疗,治疗组在对照组治疗基础上另加用舒肝解郁胶囊.疗程8周.[结果]2组内治疗前与治疗后、2组间治疗后SDS评分比较差异有统计学意义(P＜0.05).治疗组总有效率为92.98％,对照组为73.33％,2组比较差异有统计学意义(P＜0.05).[结论]舒肝解郁胶囊联合埃索美拉唑和多潘立酮治疗伴抑郁的GERD安全、有效.     

舒肝解郁胶囊治疗肠易激综合征合并抑郁症的疗效观察

[目的]观察舒肝解郁胶囊治疗肠易激综合征(IBS)合并抑郁症的临床疗效。[方法]将入选的IBS患者126例分为对照组(63例),治疗组(63例);2组均予以胃肠解痉药匹维溴胺,治疗组加用舒肝解郁胶囊,疗程均为6周;观察和比较2组患者的临床疗效以及Hamilton抑郁量表评分。[结果]治疗6周末,治疗组总有效率为92.06%,明显高于对照组总有效率(55.56%),2组比较差异有统计学意义(P0.05);治疗组治疗前Hamilton抑郁量表评分平均积分为(34.81±6.42),治疗6周末为(12.13±7.43),治疗后较治疗前积分明显下降,差异有统计学意义(P0.05);治疗组治疗6周末Hamilton抑郁量表评分平均积分较对照组(22.15±6.56)明显下降,(P0.05)。[结论]舒肝解郁胶囊治疗IBS合并抑郁症疗效显著,值得临床推广,疗程以6周为佳。     

舒肝解郁胶囊治疗伴抑郁症状肝硬化患者的疗效观察

[目的]探讨舒肝解郁胶囊对肝硬化患者伴发抑郁症状的治疗效果.[方法]51例肝硬化伴抑郁症状的患者随机分为治疗组(26例)和对照组(25例).治疗组在常规内科综合治疗基础上同时口服舒肝解郁胶囊0.72g,bid;对照组在常规内科综合治疗基础上同时口服黛力新片1片,bid;2组疗程均为4周.于2组治疗前及治疗4周末分别采用汉密尔顿抑郁量表(HAMD-17)评定抑郁情绪分值,实验室测定肝功能.采用治疗中需处理的不良反应症状量表(TESS)评定安全性.[结果]治疗4周后,治疗组和对照组有效率分别为92％、72％ (P＜0.05).治疗组HAMD评分显著下降,且治疗组的TESS评分显著低于对照组,疗效指数显著高于对照组,2组间差异有统计学意义(P＜0.05).[结论]舒肝解郁胶囊对肝硬化伴抑郁症状的患者疗效优于黛力新,且不良反应明显少于黛力新.     

伴抑郁老年胃食管反流病的联合治疗研究

目的 调查伴抑郁老年胃食管反流病患者在联合治疗中加用舒肝解郁胶囊的疗效。方法 回顾性选择2020年5月至2022年4月在河南科技大学第五附属医院治疗的伴抑郁老年胃食管反流病患者64例,在老年科、综合内科接受莫沙必利+泮托拉唑联合治疗的32例为对照组,同期在精神科治疗的32例为观察组,观察组患者在对照组用药的基础上加用舒肝解郁胶囊。比较两组治疗效果、胃食管动力学指标、不良反应发生率及抑郁情绪改善情况等。结果 治疗后观察组患者食管括约肌松弛率、蠕动收缩比及食管括约肌压力等胃食管动力学指标均优于对照组(P<0.05),观察组不良反应总发生率(6.25%)显著低于对照组(25.00%),临床总有效率和安全性均显著增高(P<0.05),且治疗后观察组患者HAMD评分显著降低(P<0.05)。结论 伴抑郁老年胃食管反流病患者在莫沙必利+泮托拉唑治疗的基础上加用舒肝解郁胶囊,既可促进胃食管反流病缓解,又能改善抑郁症状,取得了良好的综合治疗效果。     

舒肝解郁胶囊治疗进展期胃癌并发抑郁症的临床研究

目的探讨舒肝解郁胶囊治疗进展期胃癌并发抑郁症的临床疗效。方法明确诊断的82例胃癌晚期患者在化疗基础上分为治疗组41例(给予舒肝解郁胶囊治疗)和对照组41例(给予姑息治疗),两组患者使用汉密顿抑郁量表(HAMD)评定患者的抑郁状态及其舒肝解郁胶囊治疗抑郁的疗效。结果经6周治疗后,两组患者临床症状均获改善,且总有效率比较有显著性差异(P0.05),治疗组抑郁症疗效明显优于对照组(χ2=7.68,P0.01),两组治疗前后HAMD评分比较有显著性差异(P0.01)。结论舒肝解郁胶囊治疗进展期胃癌并发抑郁症,临床疗效较好。     

舒肝解郁胶囊治疗胆汁反流性胃炎疗效观察

[目的]观察舒肝解郁胶囊治疗胆汁反流性胃炎的临床疗效。[方法]选择门诊胆汁反流性胃炎患者101例,随机分为舒肝解郁胶囊治疗组(治疗组)51例、对照组50例。2组均给予雷贝拉唑胶囊20 mg、1次/d,莫沙必利5 mg、3次/d口服。治疗组在此基础上给予舒肝解郁胶囊2粒、2次/d口服。治疗4周后观察比较2组疗效、不良反应,同时在结束治疗后4周随访复发率。[结果]治疗组、对照组临床疗效总有效率分别为86%(44/51)、68%(34/50),治疗组优于对照组(P0.05);治疗组、对照组胃镜下疗效总有效率分别为80%(41/51)、62%(31/50),2组疗效比较差异有统计学意义(P0.05);治疗组与对照组复发率及不良反应比较,差异均无统计学意义(P0.05)。[结论]舒肝解郁胶囊联合西药在胆汁反流性胃炎中治疗安全、有效、预后较好,作为一种内科治疗药物值得临床推广应用。     

舒肝解郁胶囊治疗伴有抑郁症状功能性消化不良患者近期疗效观察

[目的]探讨舒肝解郁胶囊治疗伴有抑郁症状功能性消化不良(FD)患者的临床疗效及对生活质量的影响。[方法]采用汉密尔顿抑郁评分量表(HAMD-17)及健康调查简易量表(SF-36量表)评定伴有抑郁症状FD患者95例(FD组)、健康体检者90例(健康对照组)的抑郁状况及生活质量。将FD组按不同的治疗方法随机分为2亚组:治疗亚组(48例)、对照亚组(47例),对照亚组临床上给予雷贝拉唑片和(或)枸橼酸莫沙必利分散片治疗,治疗亚组在对照亚组基础上加用舒肝解郁胶囊,疗程为6周,分别记录2组治疗前及治疗后1周、2周、3周、6周末的抑郁状况及生活质量,并比较2组治疗效果、不良反应和复发率。[结果](1)FD组HAMD-17评分为(22.15±8.06)分,高于健康对照组,2组比较差异有统计学意义(P0.01);生活质量评定中躯体健康评分(physical component summary,PCS)为(32.16±12.79),精神健康评分(Mental component summary,MCS)为(38.16±17.10),均低于健康对照组,2组比较差异有统计学意义(P0.05)。(2)治疗亚组治疗前、后HAMD-17评分分别为(22.18±8.02)分、(13.16±3.48)分,PCS评分分别为(32.12±10.76)分、(56.98±18.32)分,MCS评分分别为(35.17±14.03)分、(67.29±19.32)分,治疗前、后比较均差异有统计学意义(P0.05);治疗亚组与对照亚组比较,PCS、MCS评分在治疗2周后至6周末均差异有统计学意义(P0.05),HAMD-17评分在治疗6周末差异有统计学意义(P0.05)。(3)治疗亚组总有效率87.50%明显优于对照亚组,2组比较差异有统计学意义(χ2=11.85,P0.05);2组不良反应发生率比较差异无统计学意义(P0.05),且症状轻微未中断治疗;治疗亚组的复发率明显低于对照亚组,2组比较差异有统计学意义(P0.05)。[结论]FD患者伴有明显抑郁、生活质量降低,舒肝解郁胶囊可以提高伴有抑郁症状FD的治疗效果,能明显提高患者生活质量,起效时间在1周左右,且不良反应少,复发率低,值得临床推广应用。     

舒肝解郁胶囊治疗心力衰竭伴轻中度抑郁症的疗效观察

目的观察中药舒肝解郁胶囊治疗心力衰竭伴有抑郁症状的疗效。方法选取用汉密尔顿抑郁量表评测诊断为心力衰竭伴有抑郁症状的患者,将患者分为舒肝解郁胶囊治疗组及对照组,治疗组在常规治疗基础上加用舒肝解郁胶囊。治疗4周后再行汉密尔顿抑郁量表,观察患者治疗前后心功能情况及6min步行试验。结果治疗组患者心功能、6min步行试验的改善及汉密尔顿抑郁量表评分改善明显优于对照组。结论舒肝解郁胶囊组使心力衰竭患者的抑郁症状很快得到改善,提高了疗效。     

舒肝解郁胶囊联合西酞普兰治疗脑卒中后抑郁的对照观察

目的观察舒肝解郁胶囊联合西酞普兰治疗脑卒中后抑郁的疗效和副反应。方法将114例卒中后抑郁病人随机分为舒肝解郁胶囊组、西酞普兰组和疏肝解郁胶囊联合西酞普兰组(联合治疗组),疗程6周。采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评定疗效。以症状量表副反应量表(TESS)评定治疗中出现的不良反应。结果疏肝解郁胶囊组、西酞普兰组和联合治疗组总有效率分别为87.2%、86.5%和97.4%。疏肝解郁胶囊组和西酞普兰组疗效差异无统计学意义(P>0.05),联合治疗组优于单药治疗组(P<0.05)。单用疏肝解郁胶囊组未见不良反应,单用西酞普兰组不良反应发生率为27.1%,联合治疗组的不良反应发生率为15.9%,在不良反应方面,联合组与西酞普兰组差异有统计学意义(P<0.05)。结论舒肝解郁胶囊联合西酞普兰治疗脑卒中后抑郁疗效确切,且不良反应小。     

舒肝解郁胶囊联合四联疗法治疗幽门螺杆菌阳性胃溃疡临床观察

[目的]观察舒肝解郁胶囊联合四联疗法(埃索美拉唑、阿莫西林、胶体果胶铋、克拉霉素)对幽门螺杆菌(Hp)阳性胃溃疡的临床疗效与安全性。[方法]89例Hp阳性胃溃疡患者,随机分为观察组(45例)、对照组(44例)。对照组采用四联疗法治疗2周,然后予以埃索美拉唑抑酸治疗4周;观察组在对照组基础上从第1~6周加用舒肝解郁胶囊2片、2次/d进行治疗。观察2组患者胃泌素浓度(GAS)、胃动素浓度(MTL)、临床症状评分、疗效、Hp根除率及用药不良反应。[结果]经过6周治疗,2组患者GAS浓度、MTL浓度及临床症状评分较治疗前均有显著改善;观察组患者GAS浓度、MTL浓度及临床症状评分均显著低于对照组(P<0.05);观察组治疗总有效率为95.56%、Hp根除率为93.33%,显著高于对照组(P<0.05);观察组不良反应发生率显著低于对照组(P<0.05)。[结论]舒肝解郁胶囊联合四联疗法治疗Hp阳性溃疡相对于四联疗法可更有效缓解患者临床症状、提高溃疡愈合率和Hp根除率,不良反应相对较少,值得推广。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.